Individual
CLINTON RUSSELL STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
13771 NEWPORT AVE, SUITE 8, TUSTIN, CA 92780-4693
(714) 368-7600
(714) 368-7630
Mailing address
13771 NEWPORT AVE, SUITE 8, TUSTIN, CA 92780-4693
(714) 368-7600
(714) 368-7630
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC24623
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54220DC0246230
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
12/29/2006
Last updated
07/08/2007
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